The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis.

Arnold CM, Faulkner RA - BMC Geriatr (2007)

Bottom Line:
Falling accounts for a significant number of hospital and long-term care admissions in older adults.Many adults with the combination of advancing age and functional decline associated with lower extremity osteoarthritis (OA), are at an even greater risk.Higher TUG scores occurred for those who were older, less mobile, and with greater number of co-morbidities.

Affiliation: College of Kinesiology and School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada. cathy.arnold@usask.ca

ABSTRACT

Background: Falling accounts for a significant number of hospital and long-term care admissions in older adults. Many adults with the combination of advancing age and functional decline associated with lower extremity osteoarthritis (OA), are at an even greater risk. The purpose of this study was to describe fall and near-fall history, location, circumstances and injuries from falls in a community-dwelling population of adults over aged 65 with hip OA and to determine the ability of the timed up and go test (TUG) to classify fallers and near-fallers.

Method: A retrospective observational study of 106 older men and women with hip pain for six months or longer, meeting a clinical criteria for the presence of hip OA at one or both hips. An interview for fall and near-fall history and administration of the TUG were administered on one occasion.

Results: Forty-five percent of the sample had at least one fall in the past year, seventy-seven percent reported occasional or frequent near-falls. The majority of falls occurred during ambulation and ascending or descending steps. Forty percent experienced an injury from the fall. The TUG was not associated with history of falls, but was associated with near-falls. Higher TUG scores occurred for those who were older, less mobile, and with greater number of co-morbidities.

Conclusion: A high percentage of older adults with hip OA experience falls and near-falls which may be attributed to gait impairments related to hip OA. The TUG could be a useful screening instrument to predict those who have frequent near-falls, and thus might be useful in predicting risk of future falls in this population.

Mentions:
There were no significant differences in the number of fallers and the frequency of near-falls among the three TUG categories; but the distribution for near-fall frequency was closer to what was expected with a trend of increasing percentage of frequent near-fallers in the higher TUG scores and declining numbers of participants with no history of near-falls (Figure 3). Based on calculation of odds ratios (Table 5), participants were three times more likely to be a frequent near-faller if their TUG score was > 10 seconds or if they were over the age of 75. The odds ratio did not increase substantially using a higher cut-off for the TUG of 14 seconds for the association to a history of falls or near-falls. Because age was a potential confounder in determining the relationship of the TUG to fall and near-fall history, a post-hoc analysis was done comparing odds ratios in two groups: under age 75 and 75 years or older. The odds ratios associated with being a near-faller remained similar for both age groups: OR = 3.0 (CI 0.44 – 20.4) and OR = 2.5 (CI 0.24 – 25.7) for the younger and older group respectively. The association of TUG scores to fall history remained low and inconsistent for the two age subgroups, with no association found for TUG scores to fall history in either group. There were no other significant associations found for the other dependent variables (gender, use of walking aid, mobility level or hip pain bilateral vs. unilateral) to frequent near-falls, and there were no significant associations of TUG scores or any other factor to fall history (Table 5).

Mentions:
There were no significant differences in the number of fallers and the frequency of near-falls among the three TUG categories; but the distribution for near-fall frequency was closer to what was expected with a trend of increasing percentage of frequent near-fallers in the higher TUG scores and declining numbers of participants with no history of near-falls (Figure 3). Based on calculation of odds ratios (Table 5), participants were three times more likely to be a frequent near-faller if their TUG score was > 10 seconds or if they were over the age of 75. The odds ratio did not increase substantially using a higher cut-off for the TUG of 14 seconds for the association to a history of falls or near-falls. Because age was a potential confounder in determining the relationship of the TUG to fall and near-fall history, a post-hoc analysis was done comparing odds ratios in two groups: under age 75 and 75 years or older. The odds ratios associated with being a near-faller remained similar for both age groups: OR = 3.0 (CI 0.44 – 20.4) and OR = 2.5 (CI 0.24 – 25.7) for the younger and older group respectively. The association of TUG scores to fall history remained low and inconsistent for the two age subgroups, with no association found for TUG scores to fall history in either group. There were no other significant associations found for the other dependent variables (gender, use of walking aid, mobility level or hip pain bilateral vs. unilateral) to frequent near-falls, and there were no significant associations of TUG scores or any other factor to fall history (Table 5).

Bottom Line:
Falling accounts for a significant number of hospital and long-term care admissions in older adults.Many adults with the combination of advancing age and functional decline associated with lower extremity osteoarthritis (OA), are at an even greater risk.Higher TUG scores occurred for those who were older, less mobile, and with greater number of co-morbidities.

Affiliation:
College of Kinesiology and School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada. cathy.arnold@usask.ca

ABSTRACT

Background: Falling accounts for a significant number of hospital and long-term care admissions in older adults. Many adults with the combination of advancing age and functional decline associated with lower extremity osteoarthritis (OA), are at an even greater risk. The purpose of this study was to describe fall and near-fall history, location, circumstances and injuries from falls in a community-dwelling population of adults over aged 65 with hip OA and to determine the ability of the timed up and go test (TUG) to classify fallers and near-fallers.

Method: A retrospective observational study of 106 older men and women with hip pain for six months or longer, meeting a clinical criteria for the presence of hip OA at one or both hips. An interview for fall and near-fall history and administration of the TUG were administered on one occasion.

Results: Forty-five percent of the sample had at least one fall in the past year, seventy-seven percent reported occasional or frequent near-falls. The majority of falls occurred during ambulation and ascending or descending steps. Forty percent experienced an injury from the fall. The TUG was not associated with history of falls, but was associated with near-falls. Higher TUG scores occurred for those who were older, less mobile, and with greater number of co-morbidities.

Conclusion: A high percentage of older adults with hip OA experience falls and near-falls which may be attributed to gait impairments related to hip OA. The TUG could be a useful screening instrument to predict those who have frequent near-falls, and thus might be useful in predicting risk of future falls in this population.